He also refused to create a health care exchange, an online market allowing the uninsured to shop for coverage.

You can just see him pounding his chest as he composed the letter to U.S. Health and Human Services Secretary Kathleen Sebelius: “Both represent brazen intrusions into the sovereignty of our state.”

He included the requisite talk of guns and the obligatory thrashing of the Medicaid program. He thanked God and the founders for his right to reject the federal “power grab.”

It takes some kind of chutzpah for a governor of the state with the highest percentage of uninsured — 1 in 4, or about 6 million Texans — to draw a line in the sand and announce that nothing’s going to change.

This cowboy swagger is amusing in an Austin City Limits ad, but in a letter from the head of a sovereign state to a member of the Cabinet?

Perry seems to be in a time warp, stuck somewhere between the American Revolution and the Wild West.

It would be humorous if it were not so disastrous.

In the 11-county Central Texas region, 360,000 people are uninsured.

Central Health, the Travis County hospital district, could have saved $7 million to $8 million a year, which could have been used to more effectively provide primary care.

People’s Community Clinic could have earned $1 million for primary care (more than 10 percent of its budget).

Some of the most frequent emergency room users will continue to be the mentally ill.

Costs will continue to be shifted to taxpayers and consumers through higher insurance premiums.

Expanding Medicaid would give us $76 billion between 2014 and 2019, with Texas putting up about $6 billion from the state budget for its share. That $6 billion is far less than Texas hospitals now spend in a single year for uncompensated care.

In the last paragraph of Perry’s letter to Sebelius, he wrote, “I look forward to implementing health care solutions that are right for the people of Texas. I urge you to support me in that effort.”

Really? For 12 years, public health care providers have waited for Perry to do something about health care.

All we’ve seen is a failed executive order to inject all sixth grade girls with a vaccine to protect against a sexually transmitted virus, an immunization made by the drug company for which Mike Toomey, his former chief of staff, lobbies.

Toomey also ran the pro-Perry super PAC during his failed presidential campaign.

In an interview Monday on Fox News, Perry said that the federal government doesn’t like us anyway and their data is just “fake and false on its face. The real issue here is freedom.” Really?

As a neonatal nurse, I’ve taken care of lots of sick and premature babies and their families, and I talk to plenty of Texans outside of work.

I have never once heard anyone express concern about Texas’ sovereignty.

I have, however, heard from a whole heckuvalot of Texans worried — make that panicked — that they might not be able to get insured, they lost their insurance with their job, they can’t find a primary care provider, they might go bankrupt with medical bills, or they will have an accident or illness in which they would have to come with the $10,000 they would owe before their deductible were to kick in.

There are babies at Dell Children’s Medical Center whose care may cost $4 million to $5 million in a year, yet their insurance coverage has a $1 million annual limit.

The hospital is out that money, and their parents are hopelessly in debt. Fortunately, by 2014, annual limits will be completely prohibited thanks to the law.

On any given day, the emergency room at University Medical Center Brackenridge — and every other public hospital in Texas — is full of people waiting to see a doctor for primary care. Without insurance, they can’t just pick up the phone and make an appointment.

I invite you to try doing that. It’s a real eye-opener.

Nurses see the tragedies every day of uninsured people who have put off seeking care until it’s too late.

Lives are shortened, quality of life is destroyed and hearts are broken.

Texas legislators must see this, too, because of the 254 counties they represent, 185 are considered medically underserved and parts of 46 others fall under the designation.

Maybe when the Legislature convenes in January, its members can turn this around and take the federal government up on its offer.

Without executive leadership, it will take real guts, but lawmakers could drag Texas off the bottom of the statistics heap and get their neighbors the medical care they need.

Anne Mitchell (left) and Vickilyn Galle after their indictment in 2009

Facing a $27 billion budget shortfall, Gov. Rick Perry has revived a failed and tired idea from past legislative sessions. To save a paltry $7 million, he proposes to combine under one umbrella some of the most essential agencies in state government — the boards regulating doctors, nurses, dentists, chiropractors, podiatrists, optometrists, pharmacists, psychologists and physical and occupational therapists.

The health professions boards were created to protect the public from harm. Although sluggish from recent years’ budget cuts, they are effective in protecting us because they are separate agencies with investigators trained specifically for each respective health discipline. They make you, me and every Texan a lot safer when we seek health care.

From the economic and public safety standpoints, the governor’s one-size-fits-all gesture makes no sense at all.

It costs the state $29 million to run these boards, but through licensing fees and disciplinary fines they collectively bring in $79 million for the state’s general fund (numbers courtesy of the Legislative Budget Board and the Texas comptroller’s office).

For example, the Texas Medical Board, which oversees doctors, had a budget of $9.4 million for fiscal year 2010 but brought in $35.7 million to state coffers.

The separate regulatory boards are cash cows for the state. It makes me wonder if the governor can count.

The professions are exceedingly different, with vocation-specific investigators. Nursing experts know nothing about regulating dentistry and vice versa.

The complex Winkler County case demonstrates the importance of a separate health board to protect the public.

The medical board first investigated Dr. Rolando G. Arafiles Jr. in 2007. It found that among other unprofessional and unethical offenses, he failed to keep adequate medical records in supervising a physician assistant who was prescribing nontherapeutic drugs at a weight loss clinic. His penalty was a $1,000 fine and a three-year stipulation on his license.

The doctor relocated, and in 2009, nurses Anne Mitchell and Vickilyn Galle of Winkler County reported the doctor to the board citing numerous cases of improper care, one of which was examining the genitalia of patients in the rural emergency room whose symptoms included stomach distress, headache and sinus pain, and blood pressure and jaw problems.

When the board notified Arafiles of the complaint, he enlisted his golfing buddy, the county sheriff, to find out who reported him. After identifying the nurses through spurious means, the hospital administrator immediately fired them, and the county and district attorneys charged the nurses with misuse of official information — a third-degree felony punishable by 10 years in prison and/or a $10,000 fine.

The medical board sent a letter to the prosecuting attorneys stating that it is improper to criminally prosecute people for raising complaints with the board — that the board depends on the eyes and ears of health care professionals to carry out its duty to protect the public from improper practitioners.

After the nurses’ report, the board investigated Arafiles and charged him with poor medical judgment, nontherapeutic prescribing, failure to maintain adequate records, overbilling, witness intimidation and other violations.

Mitchell and her family endured a torturous eight months waiting for the criminal trial to determine if she would go to prison or be fined an amount she could not pay. In 2010, Mitchell was acquitted in less than an hour, making national headlines and prompting a Texas attorney general investigation into the doctor and Winkler County officials.

The medical board subsequently issued a public reprimand of Arafiles, ordering physician monitoring of his practice and a $5,000 fine. He also was ordered to complete a rigorous course followed by assessments of his competence and medical jurisprudence.

Soon thereafter, the doctor, sheriff, county attorney and hospital administrator were indicted on charges of retaliation against the nurses. They await trial.

The Winkler County case demonstrates the crucial role of a board in protecting the public. The complexity of this case likely would not have been handled effectively by an umbrella agency. Functioning as a single agency would only dilute and weaken the power to protect the public’s safety.

As the American-Statesman recounted in a recent article, a homeless man discovered the body of Samantha Harvey hanging from the limb of a cypress tree along the Town Lake hike-and-bike trail last August, her wrists freshly bandaged. Just four days before, she had deeply slashed herself, was treated at a for-profit hospital and released after a few hours. Samantha had bipolar disorder and had tried in vain to get medications and therapy when her candle burned out.

In May, Kelsey Patterson, who had intractable paranoid schizophrenia, was executed after Gov. Rick Perry refused to grant executive clemency — despite the state parole board’s rare recommendation, on a 5-1 vote, to commute the sick man’s sentence. Strapped to the gurney, Patterson ranted incoherently as the lethal drugs made their way through his veins.

By all accounts, Patterson had no idea he was about to be put to death or why, thus clearly not meeting the legal requirement for execution: mental competence. By failing to show mercy, the governor sent a message: If you commit a crime and are sick enough, by God, this state will put you to death.

Where does the blame lie for this mental health imbroglio — where people die trying to get help; where wildly delusional inmates are executed; where people with gravely serious mental problems routinely show up in hospital emergency rooms, rural family practice doctors’ offices and prison?

The blame lies squarely with every one of us. We look the other way when we see a ranting homeless person. We make no effort to try to understand complex diseases of the brain. We think criminal defense lawyers are exaggerating or faking their clients’ conditions. We think their families are at fault, or that they brought it on themselves. We think, maybe if these people would just pull themselves up by their bootstraps . . .

We watched last legislative session as our elected representatives, acting as trustees of the public, cut $14.8 million in mental health funding, even though our state already ranked 46th nationally in per-capita mental health spending. They then went on to legislate that Medicaid would no longer cover therapy by professionals such as psychologists, therapists, counselors and social workers. (The bulk of people served by the Texas Department of Mental Health and Mental Retardation are eligible for Medicaid.)

Those decisions took a tattered Texas-style mental health safety net and ripped it wide open. Forty-one community mental health centers across Texas struggle to care for our poor mentally ill. Each runs on a shoestring budget with caring, dedicated staffs who do their best to care for society’s most vulnerable. Human errors can occur in community mental health centers, just as in the best hospitals. In either setting, these failures can be fatal.

A deeply embedded stigma surrounding mental illness pervades our culture and directly affects our leaders’ decisions about funding. Our lawmakers find little public sympathy for the mentally ill, and our governor shows no mercy, no disdain for injustice, no nobility of the soul. We all have the blood of Samantha Harvey and Kelsey Patterson on our hands.

Inglis is a practicing neonatal intensive care nurse in Austin and a member of Austin Travis County Mental Health Mental Retardation Center Board of Trustees.